Osteoarthritis

Suhas Balakrishna et al. (2026) · Journal of lifestyle medicine

This systematic review and meta-analysis pooled 33 controlled studies with 2,651 adults to ask whether pelotherapy, the application of mineral-rich mud, peat or clay as packs, wraps or full baths, eases musculoskeletal disorders. These include osteoarthritis (joint cartilage wear), rheumatoid arthritis (an autoimmune joint disease), fibromyalgia (widespread pain) and chronic low back pain. Pelotherapy is a traditional naturopathic practice used in spas, balneological centres and clinics in at least 40 countries, and the authors set out to test it against modern standards: pre-registration, risk-of-bias rating and GRADE certainty scoring. The team searched eight databases and trial registers up to April 2026. Included trials enrolled adults with a confirmed musculoskeletal diagnosis, applied mud as the main treatment for 10 to 21 sessions over two to three weeks, and compared it with sham treatment, usual care, waiting lists or nothing. Pain was mostly rated on a 0-100 mm visual analogue scale or a 0-10 numeric scale, and function on questionnaires such as the WOMAC. Two reviewers worked independently and combined results with random-effects statistics. Pain dropped clearly after mud treatment (standardised mean difference -0.74, a moderate-to-large effect, roughly 18.5 mm on the 100 mm scale and above the 15 mm threshold for a meaningful change). The effect was still present at 3 months (-0.61) and at 6 months (-0.49, low certainty). Physical function (-0.69) and quality of life (+0.58 on SF-36) improved as well, with osteoarthritis trials using the WOMAC at -0.82 and rheumatoid arthritis trials using the HAQ at -0.58. Morning stiffness (-0.52) and C-reactive protein, a blood marker of inflammation (-0.44), fell modestly, while the erythrocyte sedimentation rate did not change significantly. Knee osteoarthritis showed the biggest benefit (-0.86), and Dead Sea mud the strongest peloid effect (-0.84). Serious adverse events were no more common than in controls (relative risk 0.98); about 6.5% of mud recipients had mild, short-lived skin redness, largely from heat. The authors note several limits: participants cannot be blinded to mud, peloid type, temperature and protocol varied widely, results differed between trials (I2 = 62% for pain), a correction for possible publication bias lowered the pain estimate to -0.66, most trials came from European spa settings, and safety beyond 12 months is unknown. They call for larger blinded trials with standardised peloids and longer follow-up, and frame pelotherapy as an adjunct to, not a replacement for, drug and physiotherapy care.

Philipp Klemm et al. (2026) · European journal of physical and rehabilitation medicine

This randomized, double-blind, sham-controlled trial of 38 analyzed adults in Bad Nauheim, Germany, explored whether mineral water baths for the hands ease pain from hand osteoarthritis (HOA). HOA is wear-and-tear damage in the finger and thumb joints that causes pain, stiffness and reduced grip. Balneotherapy, the treatment of conditions with natural mineral waters, is well known for knee osteoarthritis, but evidence for hand osteoarthritis was thin. The tested water was natural thermal brine, a salty spring water (sodium chloride and hydrogen carbonate, rich in carbon dioxide), used at its natural 25 degrees C. Participants averaged 72 years, 86% were women, and all had painful, X-ray-confirmed HOA. One group soaked both hands in thermal brine and the other in ordinary tap water at the same temperature, in identical covered bowls so neither participants nor staff knew which was which. Each bath lasted 15 minutes, with six baths over three weeks. Pain was rated on a 100 mm visual analog scale (VAS, 0 meaning no pain), alongside hand function questionnaires, grip strength, skin blood flow and a blood marker (VEGF). After six baths, pain averaged 7 mm with thermal brine versus 33 mm with tap water, a 26.4 mm gap (P < 0.0001) larger than the 20 mm threshold for a clinically meaningful change. The gap was already present after the first bath (5.3 mm, P = 0.0017) and was still about 26 to 27 mm at 4 and 12 weeks. Pain on the hand index (AUSCAN pain subscore) was also lower (5.86 points, P < 0.0001), though that difference was gone at follow-up. Stiffness, function, grip strength, skin blood flow and VEGF did not differ between groups. Satisfaction favored thermal brine: 72% (13 of 18) rated pain relief good or very good versus 32% (6 of 19) with tap water. No adverse events occurred. The trial was small, ran at one center during the COVID-19 pandemic, and lost 12 of 50 participants, so only 38 were analyzed. Tap water may also have effects of its own. Because blood flow and VEGF showed no change, how the baths relieve pain remains unexplained; the authors note that 25 degrees C is below the 32 to 35 degrees C range where carbon dioxide baths are expected to widen blood vessels. They propose thermal brine baths as a non-pharmacological adjunct and call for larger multicenter trials with longer treatment and optimized temperatures.

Tatiana Leite Müller et al. (2026) · International journal of biometeorology

This systematic review of nine studies with 465 adults looked at climatotherapy, the therapeutic use of climate and natural settings, for musculoskeletal and rheumatologic disorders such as osteoarthritis, rheumatoid arthritis, fibromyalgia and ankylosing spondylitis. The settings were the Dead Sea (very salty water, low humidity, distinctive solar radiation and air pressure about 5% above sea level) and coastal sites using thalassotherapy, which means bathing and exercising in seawater, sometimes with marine mud, sun exposure and sea air. Because these programs vary widely, the authors wanted to gather what trials say about pain, physical function, quality of life and safety. The reviewers searched three databases through September 2025 and included eight randomized trials and one non-randomized study from 1995 to 2011, mostly in Israel. Participants were aged 18 to 65 and stayed at a spa or coast for 10 days up to 12 weeks. Comparison groups used freshwater pools, usual care, pool exercise or the same program in Norway. Pain was usually rated on a 0 to 100 visual analog scale, and quality of life was measured with questionnaires such as the SF-36. Most studies reported short-term improvements in pain, stiffness, function and quality of life, mainly within groups. Only two studies could be pooled for pain, giving an inconclusive overall result (SMD -0.47, 95% CI -5.47 to 4.53; an interval too wide to show benefit or no benefit). Split by condition, osteoarthritis showed a large effect (SMD -1.01, meaning pain fell by roughly one standard deviation more than with comparison) while fibromyalgia showed a small non-significant one (SMD -0.18, p = 0.158). In fibromyalgia, single-study estimates showed fewer tender points (SMD -0.50, p = 0.0047) and better physical quality of life (SF-36 physical score 0.36, p = 0.0391), but mood scores (p = 0.5968) and overall fibromyalgia impact (p = 0.0612) did not change significantly. No serious adverse events were reported, though only one study recorded adverse events explicitly. The evidence has important limits: trials were small and published between 1995 and 2011, participants and therapists could not be blinded, safety was inconsistently recorded, and several programs combined many components, so the effect of the climate itself is hard to separate. Only one trial analyzed all participants as randomized, and the pooled estimate rests on two studies. Certainty was judged low. The authors suggest climatotherapy may be a complementary option, particularly for osteoarthritis, and call for multicenter randomized trials with standard outcome sets and systematic safety reporting.

Alireza Askari et al. (2024) · Frontiers in pharmacology

This randomized trial with 86 completing patients compared a traditional Persian medicine remedy — basil leaf oil blended with sesame oil — against a standard drugstore treatment, diclofenac gel, for knee osteoarthritis pain. Basil has been recommended for joint pain in Persian medical texts since Avicenna and Rhazes, roughly a thousand years ago, and this was the first study to directly test it head-to-head against a modern pharmaceutical. One hundred adults with knee osteoarthritis were randomly assigned to rub either the basil-sesame oil blend or 1% diclofenac gel onto their knees three times a day for 4 weeks; everyone could also take an as-needed pain pill if they needed more relief. Researchers tracked pain and stiffness using a standard osteoarthritis questionnaire (WOMAC), a 0-100 pain scale, how far patients could bend their knee, and how fast they could walk. Both treatments worked about equally well: there was no meaningful difference between the herbal oil and the diclofenac gel on any measure at 2 or 4 weeks, and both groups showed significant improvement in pain, stiffness and function compared to when they started. One interesting difference: people using diclofenac gel needed noticeably more rescue pain medication by the fourth week, while basil-oil users' need for extra medication stayed about the same — a pattern that could suggest diclofenac's effect wearing off faster. Importantly, nobody using the basil oil reported any side effects at all. These findings suggest this centuries-old herbal remedy may relieve knee osteoarthritis pain about as well as a standard anti-inflammatory gel, with an excellent safety record. That said, there was no "fake treatment" (placebo) group, so it's not fully clear how much of the improvement came from the oils themselves versus the natural ups and downs of the condition, and because sesame oil may have its own joint-protecting effects, the specific contribution of basil can't be pinned down. Larger studies with a placebo group and longer follow-up are needed before this becomes a routine recommendation.

YuJuan Zhang et al. (2020) · Current rheumatology reports

This review examined five years of research — 16 review articles and 11 randomized controlled trials published between 2016 and 2020 — to answer a question millions of people ask: does acupuncture actually work for chronic musculoskeletal pain? That umbrella covers osteoarthritis, rheumatoid arthritis, fibromyalgia, and chronic low back pain, which together form the leading cause of disability worldwide. About three million American adults already use acupuncture yearly, most of them for these very conditions. The reviewers, writing in Current Rheumatology Reports, held studies to clear standards: randomized trials with at least 20 adults, pain as a measured primary outcome, and a genuine control group — sham needling, waiting list, active therapy, or routine care. They excluded dry needling and moxibustion so the conclusions would apply specifically to classical acupuncture at standard points. The answer turned out to be condition-specific, and refreshingly honest. Knee osteoarthritis and chronic low back pain earned the strongest support: short-term pain relief is real, and the authors call acupuncture a safe and reasonable referral option for both — a stance Medicare has since echoed by covering acupuncture for chronic low back pain. Fibromyalgia sits in the middle: acupuncture may help, but the evidence is thinner. Hip osteoarthritis and rheumatoid arthritis land on the other side: the available evidence does not support acupuncture for either, a negative finding stated without hedging. Safety was favorable across the board. For joint or back pain, this review is essentially a map of where the evidence for acupuncture stands. It is a narrative synthesis rather than a statistical meta-analysis, so it pools no numbers of its own, and its authors close with the field''s standing caveat: the short-term benefits reported across these trials still need confirmation in larger, more rigorous studies, especially for the conditions in the middle ground.

He Chen et al. (2024) · Current pain and headache reports

Does acupuncture keep helping knee osteoarthritis after the needles stop? A 2024 systematic review and meta-analysis in Current Pain and Headache Reports pooled 10 randomized controlled trials with 3,221 participants to answer exactly that, and found benefits lasting roughly 3 to 6 months after the final session. The durability depended on the comparison. Against sham acupuncture, real acupuncture kept function measurably better for 4.5 months after treatment ended, and overall pain stayed lower through 4.5 months as well. Against usual care, both pain relief and functional improvement remained large enough to matter clinically for 5 months. One trial comparing dry needling with the anti-inflammatory drug diclofenac found relief persisting 6 months after treatment ended. Not every comparison favored acupuncture. When it was added on top of exercise-based physical therapy, it added nothing measurable for up to 11 months — exercise appears to occupy much of the same therapeutic ground. And two no-treatment-controlled trials disagreed, one showing 3 months of persistence and the other showing benefits only at end of treatment. Safety was consistently good across trials, with no significant excess of adverse events. For the estimated one in five adults over 40 living with knee osteoarthritis, the practical takeaway is that a 4-to-12-week course of acupuncture (typically 1–3 sessions weekly) can deliver relief that outlasts treatment by months — something NSAIDs and steroid injections generally cannot claim. It works best as its own treatment or alongside routine care, not stacked on structured exercise therapy, and results should be weighed knowing each individual comparison rested on relatively few trials.